Thursday, August 31, 2006

[English]Are you ambiguous, my dear?

- article published in Dagens Nyheter, 20010914

By Sara Edenheim(Translated from the Swedish by Curtis E. Hinkle)

Most people feel that biology and sex are linked together in a very obvious way - we are all born female or male. There are differing opinions as to whether to consider our gender roles as an inescapable consequence of this or that they are a culturally enforced construct. There are very many who point out that biology has very little, if anything, to do with gender roles. A very significant example is the treatment of those called intersex which is a very tangible example of how medicine and science are more or less compelled to correct "nature."

We all have a sex at birth. We are sure of that. We don't all have the same sex at birth. We are sure of that too. However, it is not well known that everyone's sex cannot be categorized as either male or female. Intersex is a relatively common phenomenon which means that the person is born with genitalia that are hard to define: micropenis/large clitoris, with/without a vagina with XY chromosomes and so forth in a series of different combinations. Intersex, in other words, is someone whose anatomy has both basic female and male elements. But what does that really mean? If we look more closely at sexual anatomy in general, we begin to see that there is not any single, "natural" distinction between the sexes that we could choose and from this viewpoint, we are all intersex really. (Many will object here that it is easy to categorize men and women: women are those who can bear children. But to choose this characteristic and to use it to define "female" is not in accordance with reality, since there are both infertile women and fertile intersex "men".)

What is meant then when we say a child has "ambiguous genitalia"? How small must a penis be to become ambiguous, how big can a clitoris be before it is seen as abnormal? The only starting point we have for coming up with a definition of intersexuality is by determining how often doctors feel it is difficult to determine the sex of a newborn. American research indicates that according to records available that doctors consider that approximately 1 newborn in 1,500 is intersex based on the appearance of their external genitalia. If we also include children that doctors consider to have "cosmetically unacceptable" genitalia, for example non-intersexed girls with a large clitoris, the statistics increase drastically. Intersexed children in Sweden are usually operated on in Astrid Lindgrens Children's Hospital in Stockholm.

Intersexuality - like transsexualism - is classified as an illness which needs to be treated by surgical intervention. There are cases of intersex in which the child's health is in jeopardy, but this is very seldom the result of how the genitalia look, but rather because of internal complications. Despite this, intersexuality is generally treated as a serious problem which 'for the best interest of the child' should be solved as soon as possible. The solution consists of different types of cosmetic surgeries, (re)construction of the genitalia, as well as informing the parents which specific sex the child 'belongs to' and eventually hormone treatments may be added. For certain, most doctors insist that in such instances the child will be socialized in his gender identity, a perspective that they share with constructivist feminist researchers. But the former are proceeding from the basis that a gender identity is absolutely necessary for a child to have a stable upbringing and a sense of integrity and wholeness, as well as the assumption that there are typical feminine and masculine characteristics and behaviors which are linked to male or female genitalia respectively. Whereas feminists are attempting to point out the disadvantages with gender roles as they exist in our society and that they do not have anything to do with bodily functions, whereas the position taken by doctors is that gender roles are essential, fixed and desirable.

According to medical professionals there are no specific regulations to determine which sex an intersex infant will belong to. All they base their decisions on are 1) the operation should take place as soon after birth as possible 2) they construct the sex which is the "easiest" in light of the physical factors present in each case 3) they will ensure that the individual, if possible, will be able to engage in sexual intercourse once adult.

In practice, this means first of all that the patient has no possibility in determining for themselves the shape and appearance of their genitalia and secondly that more intersex infants are surgically assigned female than male. This first of all involves a violation of the individuals freedom of choice. And secondly it exposes sexist and heterosexist assumptions about sex and gender. The official explanation is that it is technically simpler to construct a functional vagina than a functional penis. In one article a doctor candidly states that "a functional vagina can be constructed in virtually everyone."

In other words, there are more demands that need to be met before constructing a penis even though it is relatively simple to demonstrate that a vagina is just as complicated and therefore no simpler to construct: it is lubricated with fluids when sexually stimulated, it changes size, is sensitive, etc. The "hole" which doctors call a vagina is nothing more than a hole and cannot give sexual pleasure.

"Sexual adjustment and adaptation" in other words mean different things depending on which sex you happen to end up belonging to. The actual implementation of these routine practices end up simply being that a child with a sufficiently long penis, without a vagina and ovaries, as well as XY chromosomes, will be surgically made a boy. All other combinations are deemed by doctors to be girls. It is clear that there is something extremely special about being a man, since it requires both a certain penis size along with corresponding chromosomes that match, whereas the female category is less complicated and more flexible from this point of view. All who do not fulfill the criteria for manhood (big penis, XY chromosomes) are assigned to the "second sex". It is extremely revealing that doctors are of the opinion that it is urgent that the child which has passed the "manhood test" be operated as early as possible so as to prevent "traumatic memories of having been castrated". Children who undergo the construction of a clitoris and/or vagina, on the other hand, often wait to a period of time between seven months and up till four years old and sometimes even later. It seems apparent that no one seems to be concerned that these children will suffer from traumatic memories from having been genitally mutilated. The doctors and the experts however know since Freud's time that women have a sense of being castrated regardless.

The question which comes to mind is obvious: why do the children need to be operated on? The answer can be found in the writings of the queer theorist Judith Butler who points out that in everyday life we reproduce categories by means of language and other behavior, that is, it is performance (performative acts) which maintains difference between people. This means that it is impossible to separate sex (biology) and gender (social role). Sex is constructed in the same manner as gender. The midwife's pronouncement: "It's a boy!" is in other words the first act in the construction of the sex [of the child] since this statement contains information for those surrounding the child how they are to categorize the child's body and simultaneously how they are to interact with the child in the future.

The problem is that there are no performative behaviors which have been elaborated for us to use when we are placed before a person whose sex we cannot determine. Instead, we try desperately to add up all the "female" against all the "male" characteristics we can find in the person, so as to be able to categorize them with the characteristics which add up to the most points. This is more or less the method which the Swedish Health Service recommends for doctors to use and most likely the one we would use if presented with an individual whose sex was hard to determine. All of this is quite simply grounded in our need to answer one disturbing question: "What is this person, really?" The question is disturbing because we realize within a concrete and material context that the categories we have been taught to see as natural are either impossible to maintain or that we must revise our view concerning the binary opposition of man/woman.

The regulations associated with intersexuality have been created in order to deal with what is viewed to be a problem. Sexologists and surgeons are convinced that they are acting in the best interest of the child. To suggest that an operation is not really necessary would most likely be viewed as inhumane and with cynicism. We consider that society can not permit a child to grow up neither a girl or a boy. "It" would not have any clear gender identity! Which in reality means nothing more than that "it" would not know which toys should be played with, which careers were suitable or which box to tick off on official documents. And most of all: "it" would not have a name or even a personal pronoun, since our language is a fundamental factor in the process of creating what is masculine and what is feminine.

There is nothing that indicates that an intersexed person (who remained intersexed) would have any problem with their gender identity if those surrounding them did not treat them as different, as an object or a monster. To draw a comparison here with the debate about the right of homosexuals to adopt or to have artificial insemination is justified. Intersexed children - as well as children of homosexuals - are not reported to have any serious problems if "we" do not treat them with prejudice and stress that they are different. From a constructivist perspective there is simply no rational necessity to tick off a box which certifies which sex we are on forms and there is no logical reason to know which sex category a child belongs to unless we want to make sure that the child knows what they can and cannot do because of their sex category. The lack of rational views about this and its usefulness can have no other explanation than the politically imbued naturalisation of sex and gender differences.

The treatment of the intersex is a paradox in a legal system which expressly prohibits genital mutilation. In cases in which a girl's clitoris is operated on because it is considered too big, the paradox is obvious - we reject non-Western arguments for female circumcision as misogynist, but the question is how is the argument for mutilating a girl with a clitoris which is "too big" different from the other which is rejected as superstitious by doctors? But even in the case of intersex, we are actually dealing with nothing more than genital mutilation, for there is no other argument for operating and determining the sex of an intersexed person (or any other individual at all) than to make them fit a social norm - or a superstition if you wish.

References:

Butler, Judith: Bodies That Matter - on the discursive limits of sex,Routledge, New York (1993)

Society is more and more aware of the existence of persons whose sexual identity and also of those whose gender identity is different from the accepted social norms. Their emerging presence as a social reality has also made the public aware of the difficulties they face: physical and psychological trauma (especially as a result of treatments in childhood), difficulties within the family and one’s social circle, discrimination at school and university, in the workplace, harassment, violence, refusal of access to certain services, increased risk of suicide, drug addiction and poverty...

Summer session program – Paris, August 2006

Definition

Intersex is a medical term but one that many of us have reclaimed. It refers to anatomical states which are variations between the male sex and female sex. Every day, children are born with an ambiguous anatomy, that is, bodies with intermediate sex formation between what is standard male and standard female; these children are called intersexed. Other terms used are hermphroditism and hermphrodism. Included also are hormonal variations with atypical mixtures of male/female hormones, or chromosomal variations with some individuals having both male and female chromosomes.

History of the intersex/intergender movement in Europe

The first intersex associations were started in English-speaking countries around 10 – 13 years ago. We in Europe started a little later and it was only about 2 – 3 years ago that we started organizing in France and other French speaking countries in Europe.

What we who are intersexed have needed is the possibility to meet each other and to get to know one another because we are very isolated; we feel we are all alone in the world. It is therefore very important that the movement be well structured and organized such that it can speak on behalf of human beings who are different and so that it can provide support to persons who discover they are intersexed and also to their families, their partners and friends who are all confronting this issue which often disrupts family relations.

Arthur, who was present during the program told us his story and why he contacted the organisation and what it has meant to him: “at first, you feel really odd, and then you realize that the others feel just as odd as we do, even more; the organisation provides a lot of information because our doctors and parents do not tell to us everything, and hide a lot from us. They lie to us and by listening to the stories of others, we start feeling we can find the information we need ourselves, dig it up and even dare to start questioning and resisting the doctors who do not listen to us and we dare to start making positive changes, moving forward, because sometimes we just feel like giving up, thinking it is not worth insisting. We are odd and nothing will change it. The organisation is there to support us, to help us move forward, to make progress. I am here and I am saying what I think but others do not dare speak, to say that they are not in conformity with the norms and by getting together and meeting each other, we don’t feel so lonely.

From an anthropological point of view, the organisation works to understand how the individual intersexed person feels about her/his body, how s/he has adapted to living in his/her body and how the individual has constructed his/her own self within a social framework based on differences between sexes. For a lot of people, it seems evident that gender can be different from one culture to the other, from one country to the other and that gender is constructed socially. However, if we state that sex also is socially constructed, that seems much less obvious.

For the majority of people, sex is part of nature and it appears natural to them that it be divided into a binary. We do not agree with these premises; we feel it is important to also stress the power-based relationships and politics which are at stake in this. We live in a hetero-patriarchal society in which the female body must conform to a female gender role and express a heterosexual orientation. The intersexed are not the only people who are questioning this social construct. Many others are also, such as those who are homosexual or transsexual.

It is true that we have a tendency to talk about our intersexuality or our intergenderdness but it is imperative that we see the links and intersections with others and that we establish a synergy with them in our struggle, especially with feminists and those who are fighting racism, for example, clitoral excision in Africa and the Middle East. There are many transsexuals and trangendered people who come to our meetings and participate in our events and what we are doing. What they offer us is really an important contribution for the overall benefit of society. It is not just our struggle and only for people who have been mutilated and who have been denied their existence, it is not limited to just one community but rather a part of a more universal struggle for human rights.

OII is very active in reaching out to other communities of which we also are a part and is doing a lot to assist those who are HIV positive and those who are in the process of transitioning. Their experiences are often very oppressive. The older the person, the more likely it is that they have pasts that cannot be forgotten but only managed. Édith, who has training and experience in palliative care and helping people work through grief, is assisting them in moving away from what they were and what they were never able to be. A person whose childhood was that of a little boy will never be able to have a childhood as a little girl. One needs to work through the grieving process and integrate that into the whole person that one is becoming.

The approach is different when offering assistance to intersexed persons. It is primarily an approach based on listening because intersex conditions are very numerous and very different. We are still dependent on the medical community in forming our own definitions of who we are and we have the impression of having our backs against the wall. There was no association to assist us as a group or which took into account our common issues.

Another important part of the framework of our organization’s outreach is the work that we are involved in with the academic community and researchers. Last spring, we in OII participated in a seminar on gender and intersex in Lausanne organized by the philosopher Cynthia Krauss. There we met psychiatrists, sociologists, and anthropologists. The next stage is to get our message heard within the medical community. Our goal is to say we exist, that we do not wish to remain invisible. This is starting to happen. We want to communicate with others and help the emerging intersex voice be heard along with other voices within the LGBT community so as to change the way others view us, especially within the medical community, where most of us have been subjected to treatments often not of our own choosing. We are human beings like others and not just subjects or guinea pigs for medical treatments and experiments.

Intersex often involves a life of questioning and struggle which persists long after surgical intervention usually undertaken in childhood. Doctors feel they have resolved the “problem” by their surgical interventions but we continue to live with the results and our questions remain. Our issues are shared by many who are homosexual or transsexual and many others who question their identity and where they fit within society, who question gender roles and such social issues dealing with sex and gender.

One of the most important problems which concerns us is that of reclaiming our bodies. A lot of people have been mutilated and butchered. For us it is not “Scalpel, yes, yes” but just the opposite that we are fighting for. (Note of translator: the name of this radio program in France is “Bistouri, oui, oui” which means “Scalpel, yes, yes” because it is a transsexual radio show for the most part and part of Radio Libertaire, an anarchist radio station). As a result, many of us have real problems living after the surgery even if further reconstruction is undertaken. We would like to help them come to terms with living in the bodies they have and feeling good about themselves after the fact. Intersexed persons have a physical body but it is often pushed aside and we have difficulty integrating the body as part of who we are and saying “this is MY body.”

One of our next demands which will be a difficult struggle will be to get society and in particular the medical community and our families to accept the fact that we can exist without physical modification of our bodies. On most occasions, young children and infants are operated on without any real emergency of a medical nature to justify the surgery. The doctors simply think the penis is too small or the clitoris is too big. What we would prefer is that the child, once they reach a certain age be given the right to determine what they wish to have done, if anything, and to have the right to articulate their own identity.

Individual freedom and autonomy for all individuals should be recognized. Just because we who are intersexed are slightly different should not deprive us of the same rights that other persons have. At birth, important decisions were made for us by others. Sometimes, our parents are aware but not always and as we grow up and start to perceive that we are not what they have made us to be and want to return to our original state and reclaim our bodies, we are confronted with ethics as the doctors say and we cannot. If we wish to change our bodies, even though they had no problem at all changing our body for us, by administering hormones or by removing what we feel is no longer a part of us, we cannot. And here, OII can help us by being a voice for us along with the support of other communities, especially the trans community which is giving us a lot of support [here in France].

To justify these medical interventions, psychiatrists tell the parents that it is not possible to raise a child as neither a boy nor a girl. The norms which society has imposed are so strong that it is difficult to know what we would have chosen had we been given the chance to express ourselves at birth. However, once there is no real health risk, there should be no more treatments or operations.

It is rather paradoxical that it is very easy to have your nose redone but when you want to reclaim your original body, it is almost insurmountable.

On the same subject, you could also consider the mutilations which are practiced on girl’s bodies. The intersex/intergender movement is relatively new. But when speaking of a convergence of struggles with those of women and those who are attracted to the same sex, we find a lot of commonalities. If you do not have a body which conforms to the norms established by law and the biomedical system, if your gender is not in conformity with those same norms or if your sexuality is not, then you must submit to treatment and be cured and if necessary, against your will. All attempts are made to force the body and the individual into this hegemonic system instead of allowing the person to have a better life in the end.

Homosexuals were also considered mentally ill and transsexuals must still be diagnosed as having “gender dysphoria” in order to have access to the treatments they are seeking, in other words they must be diagnosed as having a mental disorder. Homosexuality was removed from the DSM4 which is the diagnostic manual in use for psychiatry in the United States. Being homosexual is no longer an illness. However, it used to be and it was also a crime but today it is considered possible to have a successful life as a homosexual. On the other hand, for the intersexed, we are not yet at this point where we feel that you could have a successful life if you were allowed to keep your original body. However, even if it is not obvious or it might not be easy for the first ones who live without intervention, it is possible.

It is true that this is a paradox. We live in societies where everyone is wanting to have their body “made over” whether by body building or plastic surgery and here we are demanding, almost foolishly, to be allowed to keep our original bodies. We are certainly moving against the current and not included within the media nor are we acting in ways that the mass media are reinforcing. In this sense we do have synergies with certain feminist resistance movements and in France, with the struggle of large women, or even with the struggle that the deaf face for being accepted as who they are and not being considered as handicapped.

Today we have the technology to modify all sorts of things about our bodies and what OII wishes is that it be the individual concerned who makes the decision concerning their body, that the child be able to grow up till s/he is capable of making an informed decision concerning her/his body and whether s/he wishes to be normalized more in one direction or the other.

Some people who are born intersexed identify as male and others as female. Others feel a little of both. Intergender is about what the person feels about themselves. There are persons who simply do not feel that the labels or identities of male or female have much meaning to them personally or that they are in between the two. And these people do not have a place in society. If you try to exist, you can’t because you are always forced to choose between F or M.

It is difficult to conceive because we are forced to define ourselves with reference to one of the two extremes as defined by the system. Some of us have invented other terms such as “ex-gendered” which signifies that one is outside the norm or multi-gendered, sometimes a little more “man” and at other times a little more “women” or nothing at all or polygendered.

One of our main goals is to provide information and awareness of intersex for the general public, the media, institutions of learning, health professionals and for professionals in the social sciences and legal experts also because, like the trans community, we also face legal identity issues because there are more and more intersex people who later realize that what was done to them is not in accord with who they are and they also seek changes in legal status but without having to go through transition as is required for transsexuals. In Belgium, there is a new law which was passed July 6 and we are concerned that this will require intersexed persons to go through a 2 year transition just to change their legal status.

What is going on in France. Arthur’s story.

Well, to start with we can have identity issues from the beginning. Even at birth, they are not sure if we are a girl or a boy and when the child grows up and realizes that s/he was assigned the wrong sex and wants to correct it, the child will be forced to go through a transsexual transition. It is a very daunting undertaking to reclaim one’s identity, one’s body and this is how groups and associations can help us.

What we are witnessing is the emergence of an intersex voice. We do not want this voice to be co-opted by medical doctors or psychiatrists and in this sense we feel a common struggle with transsexuals and the gay/lesbian community and also share common points with mothers and feminists who have systematically seen their voice filtered through and co-opted by the medical community.